Healthcare Provider Details

I. General information

NPI: 1467216374
Provider Name (Legal Business Name): JODYANN DELL LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 KNOLLWOOD RD STE 102
ELMSFORD NY
10523-2806
US

IV. Provider business mailing address

2157 ROUTE 44
PLEASANT VLY NY
12569-7375
US

V. Phone/Fax

Practice location:
  • Phone: 914-510-2273
  • Fax:
Mailing address:
  • Phone: 718-678-5023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number349424
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: